sake of clarity when describing a child's psychological development from infancy into
adulthood, certain developmental milestones should be considered.
The academic considerations about psychological development have been dom-inated
by a number of internationally known authorities who have, for the most part,
concentrated on different aspects of the systematic progression from child to adult.
However, the most important theoretical perspective now influencing thinking about
child development is that of attachment theory⎯a theory developed by the
psychoanalyst John Bowlby. In a series of writings over three decades, Bowlby
developed his theory that child development could best be understood within the
framework of patterns of interaction between the infant and the primary caregiver. If
there were problems in this interaction, then the child was likely to develop insecure
and/or anxious patterns that would affect the ability to form stable relationships with
others, to develop a sense of self-worth, and to move towards independence. The
other important concept to note is that development is a lifelong process, we do not
switch off at 18, nor is development an even process. Development is uneven,
influenced by periods of rapid bodily change.
The psychological literature contains many accounts of the changes accompanying
development; therefore, this section will present a general outline of the major
'psychological signposts' of which the dental team should be aware. As the newborn
child is not a 'common' visitor to the dental surgery no specific description of
newborn behaviour will be offered, instead general accounts of motor, cognitive,
perceptual, and social development from birth to adolescence will be included. It is
important to understand that the thinking about child development has become less
certain and simplistic in its approach; hence, dentists who make hard and fast rules
about the way they offer care to children will cause stress to both their patients and
themselves.
2.2.1 Motor development
A newborn child does not have an extensive range of movements, but these develop
rapidly and by the age of 2 years the majority of children are capable of walking on
their own. The 'motor milestones' occur in a predictable order and many of the tests
used by paediatricians assess normal development in infancy in terms of motor skills.
The predictability of early motor development suggests that it must be genetically
programmed. Although this is true to some extent, there is evidence that the
environment can influence motor development. This has led to a greater interest in the
early diagnosis of motor problems so that remedial intervention can be offered. A
good example of intervention is the help offered to Down syndrome babies, who have
slow motor development. Specific programmes, which focus on practising sensory-
motor tasks, can greatly accelerate motor development to almost normal levels.
Motor development is really completed in infancy, the changes which follow the
walking milestone are refinements rather than the development of new skills. Eye-
hand co-ordination gradually becomes more precise and elaborate with increasing
experience. The dominance of one hand emerges at an early age and is usually linked
to hemisphere dominance for language processing. The left hemisphere controls the
right hand and the right hemisphere controls the left. The majority of right-handed
people appear to be strongly left-hemisphere dominant for language processing, as are